Disturbances of the Heart / Discussion of the Treatment of the Heart in Its Various Disorders, With a Chapter on Blood Pressure

by Oliver T. Osborne

While weakness generally and myocarditis, at least oil exertion or nervous excitation or after eating, cause a heart to be rapid, still such a heart may act sluggishly when the patient is at rest, so that he feels faint and weak and disinclined to attempt even the slightest exertion. In such a condition calcium, iron and strychnin, not too frequently or in too large doses, and perhaps caffein, are indicated. Camphor is always a valuable stimulant, more or less frequently administered, during such a period of slow heart. This slow heart sometimes occurs after rheumatic fever; it is quite frequent after diphtheria, and may show a disturbance of the vagi.

Although the prognosis of such slow hearts after serious illness is generally good, a heart that is too rapid after illness is often more readily brought to normal by proper management than a heart which is too slow. Either condition needs proper treatment and proper management.

It is well recognized that serious, almost major hysteria may be present and the heart not only not be increased, but it may even be slowed. The heart in this condition of course requires no treatment. In cerebral disturbances, especially when there is cerebral pressure, and more particularly if there is pressure in the fourth ventricle, the pulse may be much slowed. It is often slowed in connection with Cheyne-Stokes respiration. It may be very slow after apoplexy, and when there are brain tumors. It is often much slowed in narcotic poisoning, especially in opium, chloral and bromid poisoning. Serious toxemia from alcohol may cause a heart to be very slow. It is more likely, however, to cause a heart to be rapid, unless there is actual coma.

A frequent condition causing a slowing of the heart is the presence of bile in the blood, typically true of catarrhal jaundice. Uremic poisoning and acidemia and coma of diabetes tray cause a pulse to be very slow.

Not infrequently after parturition the heart quiets down from its exertion to a rate below normal. If the urine is known to be free from albumin and casts, and there are no signs of impending eclampsia, the slow pulse is indicative of no serious trouble; but the urine should be carefully examined and a possible uremia or other cause of eclampsia carefully considered. Sometimes with serious edema and after serious hemorrhage the heart becomes very slow, unless some exertion is made, when it will beat more rapidly than normal. This probably represents a diminished cardiac nutrition.

The cardiac lesions which cause a pulse to be slow are sclerosis or thrombosis of the coronary arteries, fatty degeneration of the myocardium, and Stokes-Adams disease.

It is seen, therefore, that when a pulse is slower than normal, even below 65 beats per minute, the cause should be sought. If no functional or pathologic excuse is discovered, it must be considered normal, for the individual, and, as stated above, even 58 or 60 beats per minute are in many instances normal for men. This is especially true with beginning hypertension, and may be true in young men who are athletic or who are oversmoking but are not being poisoned by the nicotin, as shown by the fact that their hearts are not rapid, that they are not having cardiac pains, that they do not perspire profusely, and that they do not have muscle cramps. A pulse of from 50 to 55 is likely to be seriously considered by an insurance company in deciding the advisability of the risk, and below 50 must be considered as abnormal.

SYMPTOMS

If a person has been long accustomed to a slow-acting heart, there are no symptoms. If the heart has become slowed from disease or from any acute condition, the patient is likely to feel more or less faint, perhaps have some dizzines, and often headache, which is generally relieved by lying down. Sometimes convulsions may occur, epileptiform in character, due possibly to anemia or irritation of the brain. If the slow heart does not cause these more serious symptoms, the patient may feel week and unable to attend to his ordinary duties. As previously urged an abnormally slow heart after serious illness should be as carefully cared for as a too rapid heart under the same conditions. Probably often a myocarditis and perhaps some fatty degeneration are at the base of such a slowed heart after serious infections.

A heart which has not always been slow but has gradually become slow with the progress of hypertension and arteriosclerosis will often disclose on postmortem examination serious lesions of the coronary arteries.